Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

Bhatia, Manoj; Singh, Bijayendra; Nicolaou, N.; Ravikumar, K.J.

doi:10.1308/003588409x428261

Cited by 47 publications

(33 citation statements)

References 28 publications

(21 reference statements)

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“…Many studies have reported the use of steroids for treating rotator cuff lesions . On the other hand, only a few studies have reported the use of HA to treat such lesions.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, physical rehabilitation has also been used. Although both steroid and hyaluronic acid (HA) injections have been commonly used as a conservative treatment for RCT, it remains unknown which method is more effective for pain relief Moreover, repeated steroid injections may result in local tissue degradation, including tendon tearing and steroid arthropathy …”

mentioning

confidence: 99%

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Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury

Yamaguchi

Ochiai

Sasaki

et al. 2015

Journal Orthopaedic Research

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This study evaluated dorsal root ganglia from C3-C7, analyzed gait, and compared the expression of calcitonin generelated peptide (CGRP) which was a marker of inflammatory pain in a rat rotator cuff tear model in which the supraspinatus and infraspinatus tendons were detached; comparisons were made to a sham group in which only the tendons were exposed. Fluorogold was injected into the glenohumeral joint 21 days after surgery in both groups, and saline, steroids, or hyaluronic acid was injected into the glenohumeral joint in the rotator cuff tear group 26 days after surgery. The proportions of CGRP-immunoreactive neurons were higher and the gait parameters were impaired in the rotator cuff tear group compared to in the sham group. However, the CGRP expression was reduced and the gait was improved with steroid or hyaluronic acid injection compared to saline, suggesting that both hyaluronic acid and steroid injections suppressed of inflammation which thought to be provided pain relief. While there were no significant differences, the suppression of CGRP expression and the improved gait after hyaluronic acid and steroid injections suggested that both methods were effective for rat rotator cuff tear model. Keywords: rotator cuff tear model; pain relief; hyaluronic acid; dorsal root ganglion; CatWalkThe main symptoms of a rotator cuff tear (RCT) are shoulder pain and limited range of motion. Conservative treatment for RCT consists of medication, fomentation, or injections into the subacromial bursa (SAB) or glenohumeral joint (GHJ). In addition, physical rehabilitation has also been used. Although both steroid 1-3 and hyaluronic acid (HA) injections have been commonly used as a conservative treatment for RCT, it remains unknown which method is more effective for pain relief 2,4-6 Moreover, repeated steroid injections may result in local tissue degradation, including tendon tearing and steroid arthropathy. 1 Although the cause of pain in shoulder pathology has not been fully clarified, calcitonin gene-related peptide (CGRP) was found to be highly expressed in both the GHJ and SAB in a rat contracture shoulder model. These results indicate that up-regulation of CGRP might be closely related to the cause of pain in frozen shoulder; 7 the same mechanism of up-regulation of CGRP has also been hypothesized to be related to RCT of inflammatory pain. For both the GHJ and SAB, sensory information is transmitted from free nerve endings through the dorsal root ganglia (DRG) at C3-C7 to the spinal cord and brain. 8 For investigation of inflammation-related pain, evaluation at the level of the DRG is important especially the expression of CGRP.The purpose of the present study was (i) to evaluate DRG neurons innervating the GHJ and SAB using immunohistochemistry for CGRP in a rat RCT model and (ii) to determine whether steroid or HA injection would provide more effective in rotator cuff tear model. MATERIALS AND METHODSAll animal protocols were approved by the Ethics Committee of Chiba University and conducted in accorda...

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“…Many studies have reported the use of steroids for treating rotator cuff lesions . On the other hand, only a few studies have reported the use of HA to treat such lesions.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury

Yamaguchi

Ochiai

Sasaki

et al. 2015

Journal Orthopaedic Research

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show abstract

“…Also, Bhatia et al16 reported that subacromial bursa injection of steroid in patients with subacromial impingement syndrome was not the cause of damage to rotator cuff because there was no statistically significant difference between 2 groups of 230 patients with clinical findings of subacromial impingement syndrome who were treated with triamcinolone >3 times and patients who were treated <3 times when comparing the 2 groups by determining whether there was of rotator cuff damage using MRI.…”

Section: Discussionmentioning

confidence: 99%

Subacromial Bursa Injection of Hyaluronate with Steroid in Patients with Peri-articular Shoulder Disorders

et al. 2011

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ObjectiveTo investigate the additive effect of sono-guided subacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders.MethodThis prospective randomized controlled trial involved 26 patients who had shoulder pain. Group A, consisting of 13 patients, was treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml), followed by injection with sodium hyaluronate (2 ml) once a week for 3 weeks. The other 13 patients (Group B) were treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml) once a week for 3 weeks. The effects were assessed using a visual analogue scale (VAS) of shoulder pain, active range of motion (AROM), shoulder function assessment scale (SFA), shoulder disability questionnaire (SDQ) at study entry and every week from first injection until 4 weeks after the 1st injection (= 2 weeks after 3rd injection).Results(1) Demographic features and all parameters measured before injection did not show a significant difference between the 2 groups. (2) Statistically significant improvements were shown in VAS, SFA, SDQ during the 1st, 2nd, and 4th week after the first injection in both groups (p<0.05). (3) SFA showed significant improvement at 1 week after injection only in group A (p<0.05). (4) AROM of internal rotation showed significant improvement at week 4 after the 1st injection only in group A (p<0.05).ConclusionSubacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders has additive effects on functional improvement of the affected shoulder, including the AROM of internal rotation.

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“…A study by Bhatia et al found that subacromial impingement should not be considered a causative factor in rotator cuff tears. Subacromial injections of corticosteroids were shown to be effective however in the improvement of rotator cuff tendonitis for up to a 9-month period post injection which probably makes it more effective than NSAID medication [35-37]. …”

Section: Conservative Managementmentioning

confidence: 99%

The Painful Shoulder: Shoulder Impingement Syndrome

Khan¹,

Nagy²,

Malal³

et al. 2013

TOORTHJ

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Rotator cuff disorders are considered to be among the most common causes of shoulder pain and disability encountered in both primary and secondary care.The general pathology of subacromial impingment generally relates to a chronic repetitive process in which the conjoint tendon of the rotator cuff undergoes repetitive compression and micro trauma as it passes under the coracoacromial arch. However acute traumatic injuries may also lead to this condition.Diagnosis remains a clinical one, however advances in imaging modalities have enabled clinicians to have an increased understanding of the pathological process. Ultrasound scanning appears to be a justifiable and cost effective assessment tool following plain radiographs in the assessment of shoulder impingment, with MRI scans being reserved for more complex cases.A period of observed conservative management including the use of NSAIDs, physiotherapy with or without the use of subacromial steroid injections is a well-established and accepted practice. However, in young patients or following any traumatic injury to the rotator cuff, surgery should be considered early. If surgery is to be performed this should be done arthroscopically and in the case of complete rotator cuff rupture the tendon should be repaired where possible.

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Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

Cited by 47 publications

References 28 publications

Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury

Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury

Subacromial Bursa Injection of Hyaluronate with Steroid in Patients with Peri-articular Shoulder Disorders

The Painful Shoulder: Shoulder Impingement Syndrome

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